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General NPI Number Information
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NPI Number | 1538570114
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ENDOCRINOLOGY SERVICES
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | BOSQUE MAR APT.302-A
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City | RIO GRANDE
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State | PR
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Zip | 00745
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Country | US
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Telephone | 787-502-2598
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Fax |
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Provider Business Mailing Address
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Address Line | 13 CAMINO LOS BAEZ APT 802 CAMINO LOS BAEZ
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City | GUAYNABO
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State | PR
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Zip | 00971-9636
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Country | US
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Telephone | 787-502-2598
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADANETTE WISCOVITCH
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Credential |
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Telephone | 787-502-2598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9670
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License Number State | PR
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